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Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity

BACKGROUND: Clinical decision support (CDS) tools built using adult data do not typically perform well for children. We explored how best to leverage adult data to improve the performance of such tools. This study assesses whether it is better to build CDS tools for children using data from children...

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Autores principales: Sabharwal, Paul, Hurst, Jillian H., Tejwani, Rohit, Hobbs, Kevin T., Routh, Jonathan C., Goldstein, Benjamin A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8961261/
https://www.ncbi.nlm.nih.gov/pubmed/35351109
http://dx.doi.org/10.1186/s12911-022-01827-4
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author Sabharwal, Paul
Hurst, Jillian H.
Tejwani, Rohit
Hobbs, Kevin T.
Routh, Jonathan C.
Goldstein, Benjamin A.
author_facet Sabharwal, Paul
Hurst, Jillian H.
Tejwani, Rohit
Hobbs, Kevin T.
Routh, Jonathan C.
Goldstein, Benjamin A.
author_sort Sabharwal, Paul
collection PubMed
description BACKGROUND: Clinical decision support (CDS) tools built using adult data do not typically perform well for children. We explored how best to leverage adult data to improve the performance of such tools. This study assesses whether it is better to build CDS tools for children using data from children alone or to use combined data from both adults and children. METHODS: Retrospective cohort using data from 2017 to 2020. Participants include all individuals (adults and children) receiving an elective surgery at a large academic medical center that provides adult and pediatric services. We predicted need for mechanical ventilation or admission to the intensive care unit (ICU). Predictor variables included demographic, clinical, and service utilization factors known prior to surgery. We compared predictive models built using machine learning to regression-based methods that used a pediatric or combined adult-pediatric cohort. We compared model performance based on Area Under the Receiver Operator Characteristic. RESULTS: While we found that adults and children have different risk factors, machine learning methods are able to appropriately model the underlying heterogeneity of each population and produce equally accurate predictive models whether using data only from pediatric patients or combined data from both children and adults. Results from regression-based methods were improved by the use of pediatric-specific data. CONCLUSIONS: CDS tools for children can successfully use combined data from adults and children if the model accounts for underlying heterogeneity, as in machine learning models.
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spelling pubmed-89612612022-03-29 Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity Sabharwal, Paul Hurst, Jillian H. Tejwani, Rohit Hobbs, Kevin T. Routh, Jonathan C. Goldstein, Benjamin A. BMC Med Inform Decis Mak Research BACKGROUND: Clinical decision support (CDS) tools built using adult data do not typically perform well for children. We explored how best to leverage adult data to improve the performance of such tools. This study assesses whether it is better to build CDS tools for children using data from children alone or to use combined data from both adults and children. METHODS: Retrospective cohort using data from 2017 to 2020. Participants include all individuals (adults and children) receiving an elective surgery at a large academic medical center that provides adult and pediatric services. We predicted need for mechanical ventilation or admission to the intensive care unit (ICU). Predictor variables included demographic, clinical, and service utilization factors known prior to surgery. We compared predictive models built using machine learning to regression-based methods that used a pediatric or combined adult-pediatric cohort. We compared model performance based on Area Under the Receiver Operator Characteristic. RESULTS: While we found that adults and children have different risk factors, machine learning methods are able to appropriately model the underlying heterogeneity of each population and produce equally accurate predictive models whether using data only from pediatric patients or combined data from both children and adults. Results from regression-based methods were improved by the use of pediatric-specific data. CONCLUSIONS: CDS tools for children can successfully use combined data from adults and children if the model accounts for underlying heterogeneity, as in machine learning models. BioMed Central 2022-03-29 /pmc/articles/PMC8961261/ /pubmed/35351109 http://dx.doi.org/10.1186/s12911-022-01827-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Sabharwal, Paul
Hurst, Jillian H.
Tejwani, Rohit
Hobbs, Kevin T.
Routh, Jonathan C.
Goldstein, Benjamin A.
Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity
title Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity
title_full Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity
title_fullStr Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity
title_full_unstemmed Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity
title_short Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity
title_sort combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8961261/
https://www.ncbi.nlm.nih.gov/pubmed/35351109
http://dx.doi.org/10.1186/s12911-022-01827-4
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